Anxiety, electric shock sensations, low mood, dizziness and insomnia are just some of the withdrawal symptoms patients have described when coming off their pills for depression.
In some cases these are so severe, they restart their medication — either believing wrongly (or having been told by their doctor) that their symptoms are a sign of their depression coming back, or because they can’t tolerate the withdrawal symptoms.
The drugs in question are selective serotonin re-uptake inhibitors (SSRIs), which are commonly prescribed for depression.
They include fluoxetine (brand name Prozac) and citalopram (Cipramil).
New and improved: While many patients don’t have problems coming off SSRIs, others have suffered severe and longer-lasting withdrawal symptoms. This has led to a campaign, championed by Good Health, for the guidelines to be updated
The official view, set out in the National Institute for Health and Care Excellence (NICE) guidelines, is that for most people, withdrawal symptoms are ‘usually mild and self-limiting over about one week’.
The advice is to reduce the drug dose gradually. While this should normally take four weeks, the guidelines acknowledge that some people may take longer.
In practice, people do this by halving their dose twice before stopping.
While many patients don’t have problems coming off SSRIs, others have suffered severe and longer-lasting withdrawal symptoms. This has led to a campaign, championed by Good Health, for the guidelines to be updated.
NICE is drawing up new guidelines on antidepressant withdrawal, due to be published this year. However, last week that campaign received a major fillip, in the form of a report published in The Lancet Psychiatry.
The authors reviewed brain imaging studies that found even very small doses of antidepressants have a significant effect on the brain.
They also highlighted a recent Dutch study where patients were successfully able to come off their medication using tapering strips — antidepressant medication that’s put into small daily pouches, with the same or slightly lower dose than the one before.
Anxiety, electric shock sensations, low mood, dizziness and insomnia are just some of the withdrawal symptoms patients have described when coming off their pills for depression
Based on their analysis, the authors suggested that slowly reducing antidepressant doses over several months to minute amounts (as little as 1/40th of the original dose) can help avoid distressing withdrawal symptoms.
‘Most doctors mistakenly think that half or a quarter of a dose of antidepressant is small enough to stop,’ says Dr Mark Horowitz, a researcher at University College London, who co-authored the report.
‘We argue that when patients stop their drug from half, or even a quarter, of their original dose, they are still “jumping off” from a relatively high level of action on the brain to nothing.
‘This is why we recommend reducing the dose so slowly.’
His co-author, David Taylor, a professor of psychopharmacology at King’s College London, adds: ‘There seems to have been two opposing views about antidepressant withdrawal. While health professionals tend to believe withdrawal symptoms are uncommon, not severe and die away quite quickly, many patients say the symptoms feel severe, they last a long time and the recommended ways of stopping antidepressants are difficult to get through.
‘It’s perfectly possible for people to
